How Do I Break Bad News Hospice Foundation-Books Pdf

How Do I Break Bad News Hospice Foundation
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How Do I Break Bad News 03 07 2007 16 00 Page i,How Do I Break Bad News 03 07 2007 16 01 Page ii. How Do I Break Bad News 03 07 2007 16 01 Page 1,Introduction 3. What is Bad News 4,Principles of Breaking Bad News to Patients 5. How Should I Tell Bad News 7,Telling the Bad News 12. Breaking Bad News to a Sick Child 16,How Do I Handle Difficult Questions 17.
When Sudden Death Occurs 20,Guidelines on Giving Bad News By Telephone 25. References 28,How Do I Break Bad News 1,How Do I Break Bad News 03 07 2007 16 01 Page 2. How Do I Break Bad News 03 07 2007 16 01 Page 3,INTRODUCTION. Introduction, This booklet aims to offer guidance and support to members of a. multidisciplinary team involved in breaking bad news to. patients their families and or significant others It is to ensure. that as far as possible any trauma involved in hearing bad news. should relate to the actual news and not to the manner in which. it is imparted, This guide is to aid best practice It is not intended to be.
prescriptive At times best practice is not possible for a variety of. Each team member has a duty to respect patient confidentiality. and to demonstrate responsibility towards any information. relevant to the patient When involved in breaking bad news we. must be aware as staff of the potential consequences and the. need to be accountable for our actions, These guidelines were developed as part of the Care for People. Dying in Hospitals Project an Irish Hospice Foundation initiative. in partnership with the Health Service Executive Dublin North. East This is an adapted second edition In developing this. document we gratefully acknowledge the kind permission of the. Mater Misericordiae University Hospital Dublin to use its. guidelines on communicating bad news,How Do I Break Bad News 3. How Do I Break Bad News 03 07 2007 16 01 Page 4,What is Bad News. Buckman says bad news is any news,that drastically and negatively alters. the patient s view of his or her future,Thayre and Hadfield suggest that.
losses may take many forms,a loved one s death devastating. diagnosis which shatters hopes,dreams aspirations disability. impairment or poor prognosis,confirming or confronting the. recipient s worst fears,How Do I Break Bad News 03 07 2007 16 01 Page 5. PRINCIPLES OF BREAKING BAD NEWS,Principles of Breaking Bad News to Patients.
Patients have a right to,Accurate and true information. Receive or not receive bad news, Decide how much information they want or do not want. Decide who should be present during the consultation i e. family members including children and or significant others. Decide who should be informed about their diagnosis and. what information that person s should receive,Patients and circumstances differ. The impact of bad news is influenced by the difference between. the patient s expectations including his or her ambitions and. plans and the medical reality of the situation Buckman 1992. When breaking bad news to patients and or their family and. significant others their capacity to understand the information. being offered should be considered While the legal age of consent. for medical treatment is 16 in general when dealing with people. under 18 their parents or guardians should be involved. We should also respect denial of bad news which is a natural. response Communication happens through time not only in. one place and location Consider communication as a process. and plan for follow up Different types of communication are. appropriate in different situations such as communications. between patient family and professional between patient and. family and between professionals,How Do I Break Bad News 5. How Do I Break Bad News 03 07 2007 16 01 Page 6,A Process for Breaking Bad News.
Elicit person s,understanding,NO Does person know YES. or suspect the truth,Fire warning shot Explore level of. Break news at Confirm news at,person s pace in person s pace. manageable chunks,Acknowledge,immediate reactions,Allow person time. for initial shock,Deal with emotional,reactions questions.
Offer support,as appropriate, Recommended manner of breaking bad news Faulkner 1998. The standard by which we should assess the quality of how we. have broken bad news to patients is to ask ourselves. If the person was my relative would I have been happy with how the. news was given,How Do I Break Bad News 03 07 2007 16 01 Page 7. HOW SHOULD I TELL BAD NEWS,How should I tell bad news. Identify correct patient and family, It is vital that the team first identify the correct patient and. where appropriate the correct family members and or. significant others who have permission to be informed The. person breaking the bad news is responsible for ensuring that all. information available is accurate and relates to the correct. patient All shared information must be documented in the. named patient s record,Who should break bad news, Ideally bad news should be imparted by the lead consultant or.
senior non consultant hospital doctor who is known to the. patient or in whom the patient has trust In the exceptional. circumstances of sudden death See page 20 a senior member of. the nursing staff may have to break bad news In essence the task. of breaking bad news should not usually be given to junior staff It. is recommended that one other member of the multidisciplinary. team such as a nurse social worker or pastoral carer should be. present or at least available when bad news is being broken and. during ongoing consultations,Who else should be informed. If members of the multidisciplinary team actively involved in. the immediate direct care of the patient are absent during the. breaking of bad news the absent members of the, multidisciplinary team should be informed as soon as possible. Such discussions should be documented in the patient s clinical. notes and should include the key phrases that were used With. How Do I Break Bad News 7,How Do I Break Bad News 03 07 2007 16 01 Page 8. the patient s consent the general practitioner and other medical. advisers should be promptly informed about what the patient. has been told and how he she has responded to the information. Where should I tell bad news, The location for telling bad news is important Every effort should. be made to ensure privacy and confidentiality and to help the. patient feel comfortable If the patient is bed bound it may be. necessary to transfer the patient in his her bed to a suitably. private room If possible but only with the patient s permission. try to ensure that the patient has the support of a key relative or. friend of their choosing while the bad news is being broken It is. ideal if you can get a private room with comfortable chairs at an. even height and with no objects or furniture such as a desk. between the person giving the information and the patient and or. others in receipt of the bad news, Pagers and mobile phones can be disruptive It is best to leave.
them with a colleague or ensure the volume is turned down You. should also apologize if it is vital to bring a pager mobile phone. into the meeting A Meeting in Progress or Do not Disturb. notice on the door is also helpful as it can help to avoid. unnecessary and distressing interruptions, The discussion might need to be conducted by the patient s bed. side Check with the patient that this is agreeable If so the. curtains should be drawn The person relaying the bad news. should also try to sit near the patient at eye level rather than. standing at the end of the bed, Consider the volume of your communication bear in mind that. curtains are not sound proof and you may be conveying information. that is distressing both to the patient and to others around him or her. How Do I Break Bad News 03 07 2007 16 01 Page 9,HOW DO I TELL BAD NEWS. When do I tell bad news, As early as possible in the diagnostic process the multidisciplinary. team should begin to prepare the patient for the possibility of bad. news It should be a goal of good practice that patients are. informed of significant information as soon as it is confirmed. provided they are in a fit state to receive the information and have. access to support should they wish Be mindful that some. patients prefer to receive bad news by themselves and their wishes. must also be respected, In many cases the need to break bad news can be anticipated for.
example during the post surgery ward round or following the. arrival of histology reports It is vital that sufficient time be set. apart for communicating bad news and that it be planned into. work schedules,What should a patient be told, The definitive answer is the truth and nothing but the truth. The doctor s primary responsibility is to the individual patient. Responsibility to relatives and or significant others is important. but secondary However always ask the patient how much. information they already have about their condition and how. much they want to know, Knowing how much information the patient wants to receive. will guide you in informing them without overloading them. with information It also gives the patient a sense of some. control over the process, Remember it can be difficult to take in information while bad. news is being broken As Buckman 2007 states it is always. How Do I Break Bad News 9,How Do I Break Bad News 03 07 2007 16 01 Page 10. worth asking the patient if he or she would prefer to be fully. informed or if they would rather that you talk with a family. member or friend about their medical situation It is important. to obtain the patient s permission to discuss his or her care with. family members or friends, Take your lead from the patient Listening to their concerns.
conveys respect and acknowledging that the news is difficult for. them is also helpful, To ensure that the patient understands any implications give. accurate and reliable information The information given should. reflect the needs of the patient at that time for example if. consenting to a procedure or treatment or requesting more. information on an illness or prognosis It is often difficult for. people to take in all the information during one meeting It may. be necessary to arrange a follow up meeting to allow the patient. to come to terms with the news and to ask any additional. questions they might need answered, The patient not the family should be the first person to be. informed of the news except in the case of a minor Patients. with an intellectual disability or cognitive impairment or who. are minors have a right to information regarding their health. This should be approached with special preparation and. sensitivity and should involve people who can support the. individual like family members significant others or care. workers who know the person well, It is good to use non verbal cues to convey warmth sympathy. encouragement or reassurance to the patient,How Do I Break Bad News 03 07 2007 16 01 Page 11. VARYING RESPONSES TO BAD NEWS,Varying responses to bad news.
People have varying responses when receiving bad news. Some common ones are,Denial Shock,Anger Guilt,Blame Agitation. Helplessness Sense of unreality,Misinterpreting information Regret anxiety. Cultural and language difficulties, If there are language difficulties a trained and independent. non family interpreter should be used Never use young. children even if they are the only ones available with the. language skills If using an interpreter face to face rather than. telephone conversations are preferred Be aware that the culture. race religious beliefs and social backgrounds of the patient. families and or significant others may affect how he she deals. with the information received If you are unsure about. particular cultural implications always ask for more information. never make assumptions,How Do I Break Bad News 11,How Do I Break Bad News 03 07 2007 16 01 Page 12. Telling the Bad News,How do I give information, Before proceeding to tell the bad news it is important to assess.
the patient the family and or significant other s understanding. of the situation This should be done prior to and throughout. the meeting This allows the patient to recap and to tell you. what they know about their medical situation You will then get. a sense whether the patient has an idea of the seriousness of his. or her condition Here are a few questions that Buckman 2007. suggests can be used to ascertain this information. What did you think was going on with you when,you felt the lump. What have you been told about all this so far, Are you worried that this might be something serious. It is important to note the language and vocabulary that the. person uses and it is good to use the same vocabulary in your. responses Lubinsky cited in Buckman 2007 points out that this. alignment is very important because it will help you assess the gap. between the patient s expectations and the actual medical. situation this is often unexpectedly wide It also helps your. patient understand what you are saying if you use the same level. of vocabulary particularly in this possibly overwhelming time. Before you break bad news prepare your patient that bad news is. coming for example The results are not as good as we. expected Yes it could be serious We are concerned by.

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